The article quotes Janet Wozniak, a child and adolescent psychiatrist who is the associate director of the Bressler Program for Autism Spectrum Disorders at Massachustts General Hospital:

For Wozniak’s patients, mainly children and teens on the autism spectrum with psychiatric disorders, simply coming to the office can be harrowing. So when the opportunity arose to take part in a pilot program for telepsychiatry, Wozniak was hopeful. She approached a few families she thought might be interested — ideally, those who lived far from the hospital and had some degree of “computer savvy.” All they needed was a computer or tablet with a camera, speakers, and Internet connection to download the hospital’s telemedicine software. Skype and other similar applications aren’t strictly compliant with HIPAA privacy rules and regulations, and so while some practitioners — like Carmichael, who alerts her patients to this potential drawback — do use Skype, MGH uses its own software.

Anyone who’s used Skype, particularly for romantic reasons, knows that you can have very intimate conversations. The extra distance might actually allow more self-revelation,” noted Peter Yellowlees, a professor of psychiatry at the University of California Davis, who conducts research on online consultation services and uses video-conferencing technology in his own practice. “I’ve had many people tell me things on video that they wouldn’t necessarily share in person.”

We are proud to say that HealthLinkNow isn’t using Skype, they are using SBR Health.

In recent years, video communications (e.g. videoconferencing and telehealth) capabilities have gone from being expensive, hardware-based resources to inexpensive, cloud-based resources. Now, the driver for wide-scale adoption in healthcare is not what this technology costs, but rather how smoothly and seamlessly it can be integrated into existing clinical workflows, IT systems, and business environments.

So how does one get started? Well, the first inclination may be to reach out to your local telecommunications or media services company. However, high-quality video no longer requires special hardware or expertise. You can now get high-quality, high-definition video on devices that you, your organization, or your employees already own (newer smartphones and tablet computers) and which many would-be patients/consumers now have or could readily obtain. As a rule of thumb, any mid to high-level personal or laptop computer sold in the last ten years is probably “video-conference” ready.

Here are two approaches: a “minimal” list of requirements and a recommended “ideal” setup:

External speakerphone or headset such as Jabra Speak 410 or Plantronics Savi w740

Internet

DSL or 4G connection (Minimum 500mb/sec. upload/download speed

Home-type cable/broadband connection, with 1Gb/sec. upload/download speed and less than 50ms latency

Once you’ve got the requirements in place, the next step is to provision a video conferencing service. (Note: if you’re using a PC, think of the PC as a phone, and the video service provider as the phone company, or carrier.) Generally, you can purchase HD video conferencing from a service provider for less than $50/month. This would provide a fully encrypted, HIPAA-compliant solution. And, because many video service providers will sign business associate agreements, (check this out—hipaa or CFR?) eliminating privacy and security issues.

One such video-as-a-service (VaaS) provider is Connexus (www.connexusvideo.com), a solutions provider in both traditional as well as “new paradigm” video communications technologies. Connexus’ president, Jonathan Schlesinger, states that one of the most import issues to consider when utilizing video in telehealth is what happens if a call gets interrupted for technological reasons: What are the patient support and recovery procedures?

“You want to make sure you have good procedures in place in the event a call gets interrupted,” explains Schlesinger. “Therefore, while VaaS providers can get you provisioned with a service and started in virtual healthcare delivery in literally a few minutes, it is important to spend a good deal of time to put together a strategy for urgent psychiatry situations as well as routine therapy use.” Indeed, if a patient says they are suicidal and shuts off their connection, organizations will be liable and need protocols in place to handle situations such as these.

Resources to help

These service providers – and other organizations like them – provide high quality Video as a Service (VaaS), plus needed support.

Company

Telephone

URL

Uniquness

Connexus

800-938-8888

www.connexusvideo.com

Self service

ID Solutions

877-880-0022

www.e-idsolutions.com

Extensive support options

Quest

800-326-4220

www.questsys.com

Full healthcare data services

Yorktel

732-413-1839

www.yorktel.com

Custom solutions

Xtelesis

888-340-9835

www.xtelesis.com

Cost-effective solutions

From a technology readiness point of view, Amnon Gavish, the SVP Vertical Market Solutions at Vidyo (www.vidyo.com), talks about other important but less known technology related considerations. “One of the things we have seen is that the quality (defined as high definition and low latency) of video is much more important in mental health interactions than in other telemedicine scenarios, as mental healthcare encounters are typically much longer than a traditional 5-10 minute primary care or specialist interaction. These are longer consultations so key factors in the effectiveness of using video are supporting a smooth conversational flow and consistency of experience. If the experience becomes cumbersome and video issues affect the quality of a session, the effectiveness of the session can be compromised causing the physician and patient will lose interest in meeting in this manner.”

Gavish also cautions you need to ensure the patient on-boarding is quick and foolproof. One way to do this is to have the patient bring his or her home computer to an initial session, during which you can ensure it is properly set up to receive a telehealth visit. Another option is to ask your telehealth solution provider if their software can provide a single-click or web-based software installation and test process, so you won’t have to provide user support.

Whenever you’re going to work with a patient at home, Gavish advises that “you need to do an excellent job at teaching them how to select and set up their equipment and ensure they have adequate lighting and privacy to ensure a good-quality experience.” Because it is typical to begin a therapeutic relationship with a face-to-face encounter at the provider’s office, there’s almost always an opportunity to explain important requirements, provide educational materials, and help patients ensure that they’re ready to receive a telehealth appointment.

Utilizing cloud based video visit services minimizes your financial exposure. “There are enormous business advantages with VaaS as you are able to scale up with a very, very low cost,” states Schlesinger. “Putting together the brick and mortar infrastructure for that type of footprint would be cost prohibitive, but if an organization makes that investment later, the virtual practice will help them to determine where to locate based on the volume of calls they have made.”

Telemedicine has been a market with a bright future for a long time but there are barriers to adoption due to cost, ease-of-use and reimbursement. Christopher Herot, CEO of SBR Health, is an innovator in the telemedicine space, who saw these barriers as opportunities for disruption, and is making it easy to get started and scale e-Visit programs to deliver care more effectively, and with greater operational efficiency. SBR Health’s automated call and skills routing management solutions allow healthcare providers to increase patient accessto care, reduce costs and readmission rates and extend service reach by delivering care virtually through video visits. In this interview, Chris describes how cloud-based video solutions are revolutionizing healthcare delivery by seamlessly integrating into clinical workflows to connect patients with doctors, specialists and membersof the care team in real-time, at any location and using any device.

Q: What role does video play in patient engagement, and how is it being used today?

People have known that patient engagement is key if you want to bend the cost curve in healthcare. The US spends twice as much as the most developed nations in the world on healthcare per capita, and we rank 18th in terms of life expectancy so clearly something’s wrong.

Until recently, there weren’t a lot of breakthrough ideas. One area that holds a lot of promise is applying things we’ve learned with online games and other interactive tools. We’ve learned what motivates people and that there’s no substitution for face-to-face interaction. What’s driving healthcare, more specifically health IT, these days is convenience and usability. With the widespread adoption of easy-to-use and low-cost video communications tools like Skype and Vidyo for both business and personal use, consumers are learning that real-time, interactive face-to-face communication is a very easy to use and efficient way to communicate and asking “why can’t I do that with my healthcare provider?”

Q:There’s a lot of excitement around the telemedicine bill referred to as the ‘Telehealth Promotion Act’ that proposes expanding reimbursement for telehealth services for federal programs and creates a federal standard for medical licensure in telehealth. How will this impact healthcare as we know it?

It’s time. There have been a lot of needless barricades in terms of using communication technology as a tool for conducting doctor patient visits but that’s only the tip of the iceberg. The real growth is going to come from transforming healthcare, not just automating, and doing away with the reimbursement, licensing and credentialing issues impacting telemedicine. Our theory is we can have a big impact on outcomes by not just automating traditional on-site visits but allowing people to interact in a more comfortable, frequent and less burdensome manner for both patients and providers.

Q:What have been the major barriers in using telemedicine, and do you think these can be resolved in 2013?

In the past, it’s been the reimbursement and regulatory issues. As far as technology, it’s been a cost barrier. Until late, there hasn’t been widespread consumer acceptance of face-to-face video communications. But now you have a whole generation of consumers raised on technology, and a generation of parents using technology to check on their kids.

Telemedicine has shown a lot of promise but as it’s required expensive equipment and highly trained people, progress has been slow. The future, call it telemedicine or something else, is letting patients and doctors connect with each other, regardless of location or device.

Q:The bill also includes incentives for hospitals to lower readmissions with telemedicine. What impact is SBR having on reducing readmissions? Are there any success stories you can share or relate to?

There was a recent meta-analysis done that looked at the impact of remote monitoring on the health outcomes of patients with chronic heart disease. By acquiring and transmitting real-time patient data to the care team, and creating opportunities for timely intervention, the remote monitoring programs were found to help reduce hospital readmissions and mortality rates, and also improve patients’ quality of life. The analysis demonstrated a high degree of variability with some interventions resulting in better health outcomes than others, so it’s too early to tell what the gold standard for clinical intervention is.

We’re just now at the point where we’re assessing the rate and process, and enthusiasm for adoption. What we do know is that both doctors and patients are looking forward to being able to more readily use these types of interventions.

Q:Do you anticipate more insurers will cover telemedicine in 2013? What is the argument for relaxing reimbursement constraints?

In my conversation with payers, they’re waiting for the data that indicates that they’ll save money or get better outcomes and not just a way for docs to get paid for something they used to do for free. More insurers are willing to pay on an ad hoc basis or to experiment. Everyone is waiting to see for the definitive results.

Q:Progress is slow but steady. As you’re on the forefront of change, what are your hopes and predictions for how telemedicine, particularly virtual visit programs, will help to advance and redefine care delivery today?

If you want to buy an airplane ticket, do your banking or find someone to marry you can use your cellphone, laptop, tablet, etc. The only thing you can’t easily do is use these same technologies to talk to your doctor. What I’m hearing from consumers all the time is that there’s a pent-up demand for bringing medicine into that same on-demand, low latency universe that we take for granted in every other part of your life. What’s been pleasantly surprising for us is a lot of the doctors are looking for ways to be more connected with their patients, and they really do care about providing a good experience for them. Contrary to how people look at doctors, there’s a feeling that medicine has become really impersonal, and what I’m happy to find is that doctors really want to do something about it.

Technology may allow us to deliver a more personal healthcare experience that will both make us feel better and get better.

Q: What is the easiest way to start using telemedicine, and what can I expect in return?

The implications for healthcare by incorporating video into the care delivery workflow are huge. By moving away from the expensive, hardware-based telemedicine systems to cloud-based video solutions that can be customized and require minimal change management, hospitals and healthcare systems are able to improve access to clinical resources, serve hard to reach patients, control costs, and improve patients’ health outcomes and overall experience. The world of healthcare is dynamic, and SBR Health is solving the problem of integrating telemedicine, specifically video, into clinical workflows to revolutionize care delivery to be more efficient and effective.

SBR Health and a new Boston-area nonprofit, Found in Translation, share an important core value: connecting patients and healthcare professionals through better communication. Found in Translation is the brain-child of Executive Director Maria Vertkin, who thought it would be a good idea to connect homeless, bilingual women with free job training to become medical interpreters, whose average annual salary is over $40,000. In Boston shelters, more than 40% of families identify as Hispanic/Latino (Source: Annual Census Report), and many are bilingual women.

Maria, an Israeli citizen born in Russia, saw an opportunity to help bilingual women by creating a program that offers not only a 12-week medical interpreter’s certification course, but common sense support such as child care and transportation. The Kip Tiernan Fellowship Committee at Rosie’s Place saw the opportunity too, and awarded Maria with a $40,000 start-up grant in 2011. Found in Translation graduated their first class of 21 women, selected from a pool of 164 applicants, in April 2012.

“The potential for women in this job field is tremendous,’ said Maria, who has worked as an interpreter and translator since she was a teenager. ‘Our program participants are looking at a 500% income increase. That not only helps the women and their families, it helps fill a need in the hospital workforce and improves the quality of healthcare for non-English speakers.”

Today, hundreds of low-income, bilingual women are waiting to apply for their next training cycle in 2013, hoping for an opportunity to use their language skills to create a better life for themselves and their families.

The next few months are critical for Found in Translation – additional funds are deeply needed to continue this important program. Party Around the World is the organization’s first annual fundraiser – a multi-cultural celebration with live Latin, African and Chinese lion dance performances, multi-cultural foods, and world music. It takes place at the Microsoft NERD Center in Cambridge, MA on November 16, 2012 from 6 to 10 pm. Tickets are only $55 general admission and $25 for students/starving artists.Please buy tickets, enjoy a fun night out and support this great organization!

Everything is moving to mobile these days, and healthcare is no exception. Christopher Herot, co-founder and CEO of SBR Health, is a recognized business and technology leader who has spent years developing and evaluating video, mobile and real-time video communications solutions. In this one-on-one interview, Chris shares his thoughts and predictions for how mobile technology will transform the healthcare space and beyond. From how we buy care to keeping in touch with family, mobile’s intersection and influence on our daily lives is significant.

How have you seen this shift?

There was a time when every young ambitious professional had a day planner. The iPad is now the equivalent. It’s your phone, calendar, email, entertainment, and computer – your method of communication for everything. This has really transformed a number of industries. Retailing is now different. People can do comparison-shopping using their phone. It’s even changed travel to some degree. You can get your boarding pass on your phone and check into places on Foursquare. For the longest time, it looked like healthcare was not a tech-savvy field but this is quickly changing.

What role does mobile play in the healthcare space?

iPads are taking the medical world by storm. They’re just the right form factor for healthcare. Apple reimagined what you can do with a tablet and has provided for an entirely new experience. Doctors don’t want other tablets. They want the iPad.

Some thought early tablets failed in terms of usability based on size but Apple demonstrated it wasn’t just about size but more about the user experience. There’s something truly unique about being able to type medical information while looking at your patient. This increases physician-patient engagement.

What’s the benefit?

There’s proven clinical value. Tablets have given doctors better access to tests and other medical information. A recent study published in the Archives of Internal Medicine found that iPads help doctors be more efficient at ordering tests and procedures for their patients. My thesis is that iPads allow physicians to do more in real time and make healthcare more convenient.

The real and long-term benefit of mobile technology is in bending the cost curve in healthcare. This goes beyond getting doctors to accept lower fees and cut down on unnecessary tests. The bulk of the cost is to get Americans to stop eating so many donuts. The way you make people healthier is to make it easier and convenient for people to see their doctor. This will drastically cut healthcare costs.

Why?

The demand for mobile reflects where we’re at as a society. The doctor is not always in his office ready to take your call, and so many of us are on the go. Being able to get access to the healthcare system wherever you are – work, home, out and about – is really critical. To make that work, we have to be able to see the patient and share what we see with other people. Tablets are small enough to be portable but also have real data on the screen.

How will this be adopted?

It will happen fastest where the payment model is evolving away from the fee for service. You’re seeing this with concierge practices. Once you make it easier for patients and doctors to do a virtual visit, I expect the adoption will expand to other parts of the world. There are places like the payers and insurance companies who see this as a way to improve healthcare delivery. You’ll see this first in places that have the luxury of not having to worry about restrictions. Concierge and post-acute follow up are prime examples.

SBR Health is developing the technology that will enable videoconferencing and real-time communications to benefit patients and doctors alike. Healthcare outcomes improve when collaborative communication that’s convenient takes place among doctors, specialists and patients, and we’re working to make it as simple and secure as possible.

As we start a new year, I looked back on all that we learned from the hundreds of conversations we had with doctors, patients and hospital administrators to pinpoint the top lessons that really stood out from 2011. There was a lot of frustration with the fee-for-service model and the fragmented care that it engenders, but there were a few points of concern that surprised us that I thought I would share with our readers.

When we asked patients what they wanted from their doctors, we heard they wanted someone who would really listen, take them seriously, and didn’t keep them waiting. When we talked to doctors, we learned they were frustrated by patients who didn’t show up for their appointments, follow up with their treatment plans or take their medications. While it is often said that anecdotes don’t equal data, there are corresponding statistics on the sorry level of readmissions, which can often be traced to a lack of coordination among caregivers and the need for patient engagement.

As we looked into where video communication might help, we observed that video had two very different roles to play in medicine. The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool, for example looking at a photograph of a patient’s skin or observing his performance in a neurological examination. The other role, which may be equally if not more important, was more of a consultative role to establish rapport and engender trust between the parties. Doctors refer to the “doorknob syndrome,” where the patient mentions the most significant problem as he has his hand on the doorknob to leave the room. As this is something that occurs most likely in person and least likely over the phone, video is more like being there in person. Video, like an in person visit, ensures a higher level of trust between the patient and doctor.

We also heard a lot from hospital administrators about “change management.” Doctors are avid consumers of technology, from surgical robots to smart phones, but they have little patience for tools that are supposed to help and instead create more work. Electronic medical records (EMR) are a case in point. Implementation of an EMR can cost millions (or even billions in some cases) but we have yet to encounter a health care professional who hasn’t expressed frustration with one. Enterprises everywhere need to deal with the high level of expectation conditioned by consumer IT, and health care is no exception.

When it comes to video communication, the technical requirements are pretty straightforward: high quality, low bandwidth, interoperability with existing systems, and straightforward user experience. While there may not be one technology that satisfies all those requirements at once, we at SBR Health see an opportunity in crafting a solution that combines the best of the available video technologies with applications that are compatible with the day-to-day workflow of busy clinicians, improve communication among clinicians, patients and family members, and enable more efficient and compassionate delivery of health care.

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Chris Herot is the CEO and co-founder of SBR Health. Prior to launching SBR in 2010, Chris was Chief Product Officer at VSee Lab, a provider of high quality, low bandwidth and low cost videoconferencing solutions to enterprises and governments. Chris has been a successful business and technology leader in several high growth companies, and directed the advanced technology group for several years at Lotus Development (now IBM) where he was responsible for video, mobile and real-time communications solutions.

Chris received his BS and MS degrees from the Massachusetts Institute of Technology where he was on the faculty of the group that became the MIT Media Laboratory.

Reform is a loaded word. At the 8th Annual American Health Care Congress, the challenges, strategies and objectives of healthcare reform were intimately dissected.

Among executives and thought leaders from across the healthcare industry at the two-day congress, the topic of value was a major focus point. The integration of new delivery models and providing value through collaborative partnerships between hospitals, physicians and healthcare was set as the ultimate task at hand, regarding healthcare reform.

Value is both a challenge we face and an outcome we hope to achieve. Throughout the discussions on innovation and strategies for enhancing quality, integration, engagement, outcomes and so forth, value was defined in a variety of ways. Included here, are highlights from sessions at the two-day congress.

On Clinical Integration Strategies for Improved Outcomes and Reduced Costs, speakers Robert Pryor, president CEO of Scott & White Healthcare and Douglas Strong, CEO of University of Michigan Hospitals and Health Centers, offered some valuable insight on their approaches to transitioning to value-based care with a consumer focused business model, sharing core competencies and delivering value through risk sharing partnerships, and creating employee engagement.

On Managing Financial Risks of Accountable Care – New Health Care Delivery Models, speaker Richard Afable, president and CEO of Hoag Memorial Hospital Presbyterian, shared some forward thinking ideas regarding new health care delivery models and how Harvard Business School professor Michael Porter’s idea of ‘shared value’ has really influenced their business model at Hoag.

‘Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent. This goal is what matters for patients and unites the interests of all actors in the system. If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.

The failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians’ practices, which imposes substantial costs of its own. Measuring value will also permit reform of the reimbursement system so that it rewards value by providing bundled payments covering the full care cycle or, for chronic conditions, covering periods of a year or more. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.’

Afable went on to provide examples in which value can be created that includes innovative, market based cost reductions; exceptional patient experiences; superior, safe, consistent clinical outcomes; and demonstrates improvements in the health of a community.

On Revolutionizing American Health Care using 21st Century Information Technology, Robert Pearl, Executive Director and CEO of Permanente Medical Group, ended with a demand for innovation. Through the adoption of new delivery models, real value can be achieved. “Choice is more important than circumstance. We must offer the same convenience and capabilities to Americans to provide a high value quality of care and enable health care reform.”

In the 25-minute matching sessions, where brief presentations or demos were allowed, providers and Innovators were asked to set milestones for next steps if the match appeared to be worthwhile. They either set dates and steps for next steps for further evaluation or plans to set up a pilot or test-bed opportunity.

SBR Health had a jammed packed day at the recent Mid-West BluePrint Health IT Innovation Exchange Summit in Indianapolis, IN. We were one of ten companies coming together from eight states across the nation to meet innovation and business development representatives from nine healthcare providers and payers. The format was excellent – 15 minutes for both the company and provider/payer to get to know each other and see if there were any areas of mutual interest, then 30 minute sessions for deeper dives to explore ways in which to potentially work together. Videos of some of the general meetings can be seen on the summits website, under Innovation Videos.

While we can’t talk about the specifics of these meetings, I would like to share some areas of interest that seemed to be common in terms of top of mind. Care coordination and patient connectivity seemed to be the largest common problem organizations were seeking solutions for and was on everyone’s “shopping list.” This was followed by improving care transitions and management of complex and high risk patients, especially after discharge. In a similar vein, there was a lot of interest expressed in care delivery solutions into the home, mobile technologies, and several organizations looking for technologies to support “e-visits” and remote patient management solutions. Mobile technologies was expressed in a variety of ways, and seemed to be delivery or engagement mechanism that was overlaid onto the other desires above, rather than a category of interest by itself.

Overall, the Blueprint format seemed to work well, and I was surprised by how quickly everyone engaged and how effective the format was. In fact, I overheard one hospital administrator comment “I wish all my vendor meetings were only 15 minutes long!”

If you attended the Mid-West BluePrint Summit, or have been to a similar setting where you were engaging in brief, but useful meetings, please comment below about your experiences.

SBR Health will be at the 8th Annual American Health Care Congress Exhibition to explore and evaluate post-reform integration strategies, innovative business and care delivery models, as well as health IT. Featuring two days of educational and networking opportunities, SBR is excited to join other innovators and health care executives to address the present and future challenges facing health care reform, and find solutions for improving the delivery of care.

Our work to develop televideo solutions that enable major health delivery organizations to reduce readmissions and increase access are aligned with the theme of this year’s conference—to improve the delivery of care. Our mission and belief that ‘Connection is the best medicine’ is clear. We are honored to join health care thought leaders in developing and implementing solutions for change. The foundation of health care reform is change, and through improved real-time communications capabilities, we’re driving change.

To follow us on Twitter while we’re at the conference, visit our Twitter Page.

Innovations in health and technology will coalesce at this week’s Sudler Health + Technology Convergence 2011 in New York City.

Sudler & Hennessy, a global healthcare communications agency, believes in the power of ideas and will explore the impact of these ideas at this year’s summit. In the search for seamless and effective healthcare solutions, Sudler is bringing today’s best and brightest in the healthcare sphere together for a day of open dialogue on government, payer, provider and patient needs.

On a mission to explore effective strategies for tech companies in the developing ehealth market, the Sudler Health + Technology Convergence will feature a variety of speakers and panel discussions. The first half of the day will focus on trends in patient advocacy, patient empowerment and technology with speakers that include Sachin Jain, a physician from Brigham and Women’s Hospital and Dallas Lawrence, the Chief Global Digital Strategist of Burston-Marsteller, as moderator.

Jeremy Nobel, MD, MPH of the Harvard School of Public Health, will be a featured speaker for the physicians and technology discussion. His lecture ‘New Market and Policy Drivers for Accelerating HIT Deployment and Effective Use: Time to Fasten your Seatbelts’ will focus on ways to better engage physicians to improve outcomes. Elizabeth Boehm, Principal Analyst at Forrester Research, will also address the shift from fee-based to collaborative and accountable care.

New ideas will converge in the afternoon working sessions on the reality of convergence in healthcare and opportunities for HIT growth. Participants will have the opportunity to engage with innovative healthcare and technology leaders to discuss and collaborate about possible strategies and solutions for today’s healthcare market.

Louisa Holland, Co-CEO S&H, The Americas, will deliver the closing comments, before the post conference cocktail and networking session.